One of the most dangerous aspects of unproven or ineffective alternative therapies is the harm to patients when these are used in place of scientific medicine. While most proponents of alternative therapies generally recommend them as an addition to conventional treatment, despite the lack of evidence this improves care, some advocates of alternative medicine condemn conventional therapies and claim unproven alternatives are as good or better. This is especially common in relation to cancer treatment. Promoters of alternative medicine often very aggressively criticize or deride conventional cancer treatments as harmful and ineffective. A new study adds to existing evidence that turning to alternative treatments for cancer is a very dangerous choice.
Skyler B. Johnson, Henry S. Park, Cary P. Gross, James B. Yu; Use of Alternative Medicine for Cancer and Its Impact on Survival, JNCI: Journal of the National Cancer Institute, Volume 110, Issue 1, 1 January 2018.
This study looked at human patients with a variety of cancers who chose to use various alternative treatments instead of conventional treatment. The patients were representative of the demographic characteristics typically associated with alternative medicine users: predominantly white, female, affluent, and educated. After controlling for other variables, alternative medicine use was associated with markedly lower survival times for every cancer evaluated except for prostate cancer, which tends to be very slowly progressive and much less likely to lead to mortality than most of the other cancers evaluated. The authors’ conclusions are quite clear:
we found that cancer patients who initially chose treatment with AM without CCT were more likely to die. Improved communication between patients and caregivers and greater scrutiny of the use of AM for the initial treatment of cancer is needed.
Of course, many advocates of alternative therapies will claim that this study doesn’t address the value of such treatments added to conventional medicine. However, it isn’t at all clear why therapies that evidently don’t work by themselves would add value when mixed with conventional treatments. And in any case, there isn’t yet any compelling evidence to support the integration of alternative cancer therapies with scientific medicine, and plenty of reasons to be skeptical of it. But this study reinforces existing evidence that turning to alternative medicine instead of scientific medicine when you have cancer is a potentially deadly choice.
Isn’t there evidence that placebos can have positive effect? If the alternative medicine is, say, administered by a persuasive snake oil salesmen or spiritual healer of some sort, I’d hypothesize it might have positive effect for ‘believers’ (when added to a proven treatment), though less so on veterinary medicine.
Not exactly. Placebo effects can change how we feel about our disease, so subjective symptoms (pain, nausea) and things affected by sympathetic and parasympathetic nervous activity (e.g. heart rate, blood pressure) can change with placebos. However, important objective measures of disease don’t change, so placebos make us feel a little better without actually making us better. Here is a classic example of how this can be dangerous-
Placebo Treatment for Asthma Works for the Mind but not for the Lungs
Iin animals, the situation is complex, but the biggest type of placebo effect is the Caregiver Placebo. This is an effect in which people (owners and vets) are fooled into thinking a patient is better due to a treatment when objective measures show no improvement. This is even more dangerous since we can do something that has no benefit at all and still believe we are helping!
Here’s a bit more about placebos in veterinary medicine.
I think this leaves a niche for alternative medicine where there is no proven effective cure.
My mother died of pancreatic cancer. I…and she…would have been grateful for any relief of subjective symptoms. The best that hospice could do was keep her heavily sedated with opiates. As a recovering alcoholic, she objected to opiates, but pain was so awful that she accepted them.
My father, a doctor, died of esophageal cancer. He let it go too far for surgery to be an effective option (complicated story; he was strongly bipolar, and when he diagnosed his own malady, he took the notion that dying wouldn’t be so bad). As a doctor, he had seen a lot of chemo, and decided he would prefer a shorter, more comfortable life…he spent his last months on a marajuana cloud with a caregiver who had an amazing sense of humor and a strong stomach (no nursing credentials whatsoever).
I agree, it’s different in vet medicine…both because it’s difficult to see objective value in deluding the owner, and because euthanasia is accepted and legal where the client opts against the treatment options.
Sure, the greater the urgency to intervene, the more uncertainty about the results we are willing to tolerate. If the disease is terrible and there is no known effective treatment, use of treatments with little supporting evidence may be appropriate. Of course, this doesn’t entirely eliminate the possibility that we can make things worse using such treatments. One alternative therapy was studied in people with terminal pancreatic cancer using just this line of reasoning. The patients who got the alternative not only died sooner but had poorer quality of life scores than those given conventional treatment.